CONTACTS
SUBJECTS
CBC Lab WBC 9.5 Labcorp Blood Test Results
2303 -
2303 - ..
2304 - Summary/Objective
2305 -
230501 - Follow up ref SDS 49 0000. ref SDS 48 0000.
230502 -
230503 - Labcorp blood test today found WBC 9.5 suddenly increased 50% compared
230504 - to prior patient history. ref SDS 0 RP4N Urinalysis reported Ketones
230505 - Trace Abnormal, and specific gravity elevated. ref SDS 0 MT4L
230506 - Electrolyte profile reported glucose and sodium increased. Potassium
230507 - 5.6 increased above range, ref SDS 0 KK9M, which presents risk of
230508 - "electrical problems for heart. ref SDS 0 TN3M These elevated labs
230509 - may be caused by dehydration from increased urination associated with
230510 - taking statin medication, and compounded by extended hiking exercise.
230511 - ref SDS 0 KZ5O Bilirubin decreased, but remains above range,
230512 - ref SDS 0 015M, presenting risk of liver damage from taking statin
230513 - medication. ref SDS 0 G34G Lipids improved again, with LDL-P 851
230514 - falling from 861, HDL 67 increasing from 61, and Triglycerides 59
230515 - falling from 68. ref SDS 0 U45J Indicates good response to VA
230516 - Healthcare prescribing Atorvastatin 10mg and Ezetimibe 10mg, while
230517 - hiking 1000 miles since prior lab on 140201, controlling weight with
230518 - low carb diet, and continuing daily orange juice.
230520 - ..
230521 - [On 140510 2056 received letter from Health Testing Centers
230522 - transmitting report on lab results. ref SDS 55 4Q6I
230524 - ..
230525 - [On 140514 0950 lab at VA Medical Center in San Francisco,
230526 - which omits NMR lipid testing, CBC, and Electrolytes.
230527 - ref SDS 57 X45G
230529 - ..
230530 - [On 140515 2043 VA notified consolidated test results show
230531 - progress lowering CVD risk with improved lipid management.
230532 - ref SDS 60 IM9N
230533 -
230534 -
230536 - ..
2306 -
2307 -
2308 - Background
2309 -
230901 - On 131016 1632 submit letter for agenda meeting to review lab results
230902 - scheduled 131017 1000. ref SDS 34 X45G
230904 - ..
230905 - On 140131 0815 ordered another lab - cbc, electrolytes, lipid with NMR
230906 - - from Labcor to get LDL-P. ref SDS 47 X45G
230908 - ..
230909 - On 140201 1159 had full lab with NMR lipid panel drawn at John Muir
230910 - Hospital on Treat, and by Labcorp. ref SDS 48 RP4N
230912 - ..
230913 - On 140203 1147 had partial lab drawn at VA in Martinez. ref SDS 49
230914 - KK9M
230916 - ..
230917 - On 140507 0857 ordered another full lab with NMR lipid panel.
230918 - ref SDS 54 OO5G
230919 -
230920 -
230921 -
230922 -
230923 -
230925 - ..
2310 -
2311 -
2312 - Progress
2313 -
231301 - Yesterday, placed lab order # 29443 with Health Testing Centers,
231302 - reported on 140507 0857. ref SDS 54 OO5G and confirmed with the letter
231303 - later that day, also shown on 140507 0857. ref SDS 54 XW7M This
231304 - implemented work plan in the record of prior VA lab on 140203 1147.
231305 - ref SDS 49 IL7N
231307 - ..
231308 - Today, drove to Labcorp, and met with Mark at...
231309 -
231310 - LABCORP
231311 - John Muir Medical Center
231312 - 1450 TREAT BLVD. WALNUT CREEK, CA 94595
231313 - Phone:925-937-1954 Hours:MONDAY-FRIDAY 6:30AM-9:00PM
231314 - SATURDAY 8:00AM-5:00PM
231315 - SUNDAY 9:00AM-5:00PM
231317 - ..
231318 - Mark found order # 29443 on Labcorp computer that was placed
231319 - yesterday, ref SDS 54 OO5G, and following up prior blood test at
231320 - Labcorp on 140201 1159. ref SDS 48 XO6J
231321 -
231322 - Patient Identification
231329 - ..
231330 - Order Code
231331 - 001545 Alanine Aminotransferase (ALT/SGPT)
231332 - 319417 CMP12 + 8AC + CBC/D/Plt + UA
231333 - 884247 NMR LipoProfile
231335 - ..
231336 - Total cost................ $188 .... 140507 0857, ref SDS 54 LH52
231338 - ..
231339 - Mark performed blood draw for following labs...
231340 -
231341 - [On 140510 2056 received letter from Health Testing Centers
231342 - transmitting report on lab results. ref SDS 55 4Q6I
231343 -
231344 - [On 140514 0950 lab at VA Medical Center in San Francisco,
231345 - which omits NMR lipid testing, CBC, and Electrolytes.
231346 - ref SDS 57 X45G
231347 -
231348 -
231362 - ..
231363 - CBC WBC 9.5 Increased 50% After Several Years Stable
231364 - Blood Tests Evaluate Health 5 Years After CABG x4 Surgery
231365 -
231366 - Follow up ref SDS 49 RP4N, ref SDS 48 RP4N.
231367 -
231368 - Prior VA CBC on 120509 1108. ref SDS 20 RP4N
231369 - Prior VA CBC on 120831 1524. ref SDS 21 RP4N
231370 - Prior VA CBC on 121130 1001. ref SDS 25 RP4N
231371 - Prior VA CBC on 130529 0818. ref SDS 31 RP4N
231372 - Prior Labcorp CBC on 140201 1159. ref SDS 48 RP4N
231373 - VA did not order CBC for lab on 140203 1147. ref SDS 49 YX8K
231374 - Prior Labcorp CBC on 140508 1149. ref SDS 0 RP4N
231376 - ..
231377 - CBC........... 2014 05 08 1149 140203 140201 130529
231378 - Labcorp VA Labcorp VA VA Labcorp
231379 - Blood Results Results Results Results Units Range Range
231380 - WBC 9.5 6.2 7.4 K/cmm 4.8 - 10.8 3.4 - 10.8
231381 - RBC 5.21 5.13 5.09 M/cmm 4.7 - 6.1 4.14 - 5.80
231382 - HGB 15.1 15.2 15.0 g/dL 14 - 18 12.6 - 17.7
231383 - HCT 47.0 44.2 46.2 % 42 - 52 37.5 - 51.0
231384 - MCV 90.0 86.0 90.7 fL 80 - 99 79.0 - 97.0
231385 - MCH 29.0 29.6 29.5 uug 27 - 34 26.6 - 33.0
231386 - MCHC 32.1 34.4 32.5 gm/dL 32 - 35.2 31.5 - 35.7
231387 - RDW 13.8 13.7 14.4 % 11.5 - 14.5 12.3 - 15.4
231388 - PLT 329 303 279 K/cmm 130 - 400 155.0 - 379.0
231389 - MPV 8.8 fL 7 - 10.4
231390 - NEUT % 70 69 69.9 % 40 - 80 40.0 - 74.0
231391 - LYMPH % 20 21 L 19.7 % 20 - 51 14.0 - 46.0
231392 - MONO % 8 8 7.8 % 2 - 13 4.0 - 12.0
231393 - EOS % 1 1 1.9 % .5 - 7 0.0 - 5.0
231394 - BASO % 1 1 0.7 % 0 - 2 0.0 - 3.0
231395 - NEUT # 6.7 4.3 5.2 K/cmm 1.5 - 7.9 1.4 - 7.0
231396 - LYMPH # 1.9 1.3 1.5 K/cmm 1.2 - 3.4 0.7 - 3.1
231397 - MONO # 0.7 0.5 0.6 K/cmm .2 - 1.2 0.1 - 0.9
231398 - EOS # 0.1 0.1 0.1 K/cmm .1 - .5 0.0 - 0.4
231399 - BASO # 0.1 0.1 0.1 K/cmm 0 - .2 0.0 - 0.2
231400 - ESRmVES mm/hr 0 - 10
231401 - ESRxCYT mm/hr 2 - 10
231402 - RETIC % % .66 - 2.85
231403 - RETIC # k/uL 27.9 - 121.6
231404 - Immature Granulocytes 0.0 0.0 % 0.0 - 2.0
231405 - Immature Grans (Abs) 0.0 0.0 % 0.0 - 0.1
231407 - ..
231408 - Comments:
231409 -
231410 - a. Test Performed at...
231411 - Health Testing Centers
231412 - 2760 W. OAKLAND PARK BLVD.
231413 - FORT LAUDERDALE FL 33311
231415 - ..
231416 - What might elevate WBC 50%?
231418 - ..
231419 - Increased exercise explained below, ref SDS 0 I17G, may have
231420 - stimulated bone marrow to produce more new blood that elevated WBC,
231421 - explained by Doctor Johnson during a meeting at Kaiser on 030606.
231422 - ref SDS 1 JP7G
231423 -
231424 - [On 140514 0950 VA lab did not include CBC, so cannot cross
231425 - check WBC 50% increase in Labcorp test. ref SDS 59 FK6I
231426 -
231427 -
231428 -
231429 -
231430 -
231431 -
2315 -
SUBJECTS
Urinalysis Gross Exam Laboratory Test Satisfactory Within Range Labc
3503 -
350401 - ..
350402 - Urinalysis Gross Exam Laboratory Test Satisfactory Within Range
350403 - Ketones Abnormal May Reflect Burning Fat with Extended Exercise
350404 -
350405 - Follow up ref SDS 49 0X72, ref SDS 48 0X72.
350406 -
350407 - Prior Urinalysis test on 101207 0906. ref SDS 9 0X72
350408 - Prior Urinalysis test on 120509 1108. ref SDS 20 0X72
350409 - Prior Urinalysis test on 140201 1159. ref SDS 48 0X72
350410 - VA did not order urinalysis for lab on 140203 1147. ref SDS 49 0X72
350411 - Prior Labcorp CBC on 140508 1149. ref SDS 0 0X72
350413 - ..
350414 - URINALYSIS.....2014 05 08 1149 140203 140201 120509
350415 - Labcorp VA Labcorp VA VA Labcorp
350416 - Results Results Results Results Units Range Range
350417 - PH 5.5 5.5 6.0 5 - 9 5.0 - 7.5
350418 - PROTEIN NEG NEG NEG mg/dL NEG - TRACE NEG - TRACE
350419 - GLUCOSE NEG NEG NEG mg/dL Ref: NEG NEG
350420 - KETONES Trace Abnormal NEG NEG mg/dL Ref: NEG NEG
350421 - BILI NEG NEG NEG Ref: NEG NEG
350422 - BILIcnf Ref: NEG
350423 - BLOOD TRACE TRACE TRACE Ref: NEG
350424 - NITRITE, URINE NEG NEG NEG Ref: NEG NEG
350425 - UROBILI 0.2 0.2 0.2 EU/dL .2 - 1 0.0 - 1.9
350426 - LEU EST NEG Ref: NEG
350427 - SP.GRAV H 1.036 1.026 1.025 1.003- 1.035 1.005 - 1.030
350428 - COLOR YELLOW YELLOW YELLOW
350429 - APPEAR CLEAR CLEAR CLEAR
350430 - WBC ESTERASE NEG NEG
350431 - OCCULT BLOOD NEG NEG NEG
350433 - ..
350434 - Comments:
350435 -
350436 - a. Test Performed at...
350437 - Health Testing Centers
350438 - 2760 W. OAKLAND PARK BLVD.
350439 - FORT LAUDERDALE FL 33311
350440 -
350442 - ..
350443 - Notes on Urinalysis Lab
350444 -
350445 - Internet research seems to indicate Ketones trace abnormal may occur
350446 - with dehydration. Customer hiked 1000 miles the past 3 months, hiked
350447 - 22 miles yesterday, and another 11 miles this morning before the lab,
350448 - possibly causing some dehydration, reported in case study on 120101
350449 - 0900. ref SDS 15 4G5I
350450 -
350451 - [On 140608 1056 article reporting fasting increases WBC to
350452 - strengthen immunity; comment explains when body burns fat
350453 - tissue for fuel, ketones begin to flow. ref SDS 65 G847
350455 - ..
350456 - Need comment from VA on Ketones and Specific gravity labs.
350457 -
350458 -
350459 -
350460 -
350461 -
350462 -
350463 -
3505 -
SUBJECTS
Lab Electrolytes Chem Profile Glucose 97 Sodium NA 144 Potasium K 5.
5203 -
520401 - ..
520402 - Total Bilirubin 1.3 Improvement Low Dose Atorvastatin Ezetimibe
520403 - Hyperbilirubinemia Improved Low Dose Atorvastatin Ezetimibe
520404 - Potasium K 5.6 Elevated Increased Electrical Problems Heart
520405 - Bun/Creatinine Ratio Elevated Slightly
520406 -
520407 - Follow up ref SDS 49 KK9M, ref SDS 48 KK9M.
520408 -
520409 - Good results today align with increased hiking and weight loss past 3
520410 - months, reported in case study on 120101 0900, ref SDS 15 LO5O, and
520411 - reflect changes in diet with adding minimal medication, reported on
520412 - 140202, in the same study. ref SDS 15 GH4M
520414 - ..
520415 - Prior CHEM PROFILE on 120509 1108. ref SDS 20 KK9M
520416 - Prior CHEM PROFILE on 120831 1524. ref SDS 21 KK9M
520417 - Prior CHEM PROFILE on 130228 1140. ref SDS 29 KK9M
520418 - Prior CHEM PROFILE on 130529 0818. ref SDS 31 KK9M
520419 - Prior CHEM PROFILE on 131015 0724. ref SDS 33 KK9M
520420 - Prior CHEM PROFILE Labcorp on 140201 1159. ref SDS 48 KK9M
520421 - Prior CHEM PROFILE on 140203 1147. ref SDS 49 KK9M
520422 - Prior CHEM PROFILE Labcorp on 140508 1149. ref SDS 0 KK9M
520423 -
520424 - [On 140510 2056 received letter from Health Testing Centers
520425 - transmitting report on lab results. ref SDS 55 4Q6I
520427 - ..
520428 - ELECTROLYTES - CHEM PROFILE
520430 - ..
520431 - CHEM PROFILE...2014 05 08 1149 140203 140201 131015 130529
520432 - Labcorp VA Labcorp VA VA VA Labcorp
520433 - PLASMA Results Results Results Results Results Units Range Range
520434 - GLUCOSE 97 103 98 108 H 120 mg/dL 74 - 118 65.0 - 99.0
520435 - GLUfast mg/dL Ref: <=99
520436 - NA (salt) 144 140 140 139 139 mmol/L 136 - 144 134.0 - 144.0
520437 - K (potasium) H 5.6 H 5.4 4.8 4.3 H 4.9 mmol/L 3.4 - 4.8 3.5 - 5.2
520438 - CL 105 103 102 105 105 mmol/L 98 - 106 97.0 - 108.0
520439 - CO2 30.0 37.0 30.0 mmol/L 23 - 33
520440 - BUN/Creati Ratio H 23 17 20 24 18 mg/dL 8 - 26 10.0 - 22.0
520441 - CREAT 0.97 0.82 0.81 0.83 0.83 mg/dL .5 - 1.1 0.76 - 1.27
520442 - eGFR INA 79 >60 91 >60 >60 mL/min Ref: >=60 >59
520443 - eGFR IA 92 106 mL/min >59
520444 - CALCIUM 9.5 9.3 9.4 9.2 9.2 mg/dL 8.7 - 10.2 8.6 - 10.2
520445 - CA CORR mg/dL 8.7 - 10.2
520446 - PO4 mg/dL 2.4 - 4.5
520447 - MG 85 mg/dL 1.8 - 2.5
520448 - ALK PHO 100 105 84 87 IntUnits/L 37 - 107 39.0 - 117.0
520449 - ..
520450 - T. BIL H 1.3 H 2.1 H 1.6 H 1.7 H 1.3 mg/dL .3 - 1.2 0.0 - 1.2
520451 - D. BILI 0.32 0.3 0.34 < 0.1 mg/dL .1 - .4 0.00 - 0.40
520452 - Bilirubin, Indir 0.98 1.26 H mg/dL 0.10 - 0.80
520453 - AST 26 23 21 20 22 IntUnits/L 8 - 42 0.0 - 40.0
520454 - ALT 17 21 19 17 19 IntUnits/L 5 - 55 0.0 - 44.0
520455 - ALBUMIN 4.6 4.1 4.4 3.9 4.0 g/dL 3.3 - 4.8 3.6 - 4.8
520456 - PROTEIN 6.6 6.7 6.5 7.1 7.2 g/dL 6.5 - 8.1 6.0 - 8.5
520457 - Globulin, Total 2.0 2.1 g/dL 1.4 - 4.5
520458 - A/G Ratio 2.3 2.1 1.1 - 2.5
520459 - LDH 200.0 180.0 IntUnits/L 90 - 208 0.0 - 225.0
520460 - GGT 11.0 9.0 IU/L 0.0 - 65.0
520461 - Iron, Serum 100.0 114.0 ug/dL 40.0 - 155.0
520462 - AMYLASE Units/L 28 - 100
520463 - LIPASE Units/L 7 - 58
520464 - NH3 mcmol/L 15 - 56
520465 - URIC AC 5.6 mg/dL 4.8 - 8.7 3.7 - 8.6
520466 - Cholesterol, Total 164.0 162.0 mg/dL 100.0 - 199.0
520467 - Triglycerides 55.0 64.0 mg/dL 0.0 - 149.0
520468 -
520470 - ..
520471 - Comments:
520472 -
520473 - a. Test Performed at...
520474 - Health Testing Centers
520475 - 2760 W. OAKLAND PARK BLVD.
520476 - FORT LAUDERDALE FL 33311
520477 -
520478 -
520480 - ..
520481 - Notes on Electrolytes Lab
520482 -
520483 - Follow up ref SDS 49 G34G.
520484 -
520485 - 1. T Bilirubin 1.3................. ref SDS 0 015M
520486 -
520487 - Bilirubin 1.3 in lab today, remains 10% high after ending
520488 - Rosuvastatin 17 months ago on 121206 0900, ref SDS 26 OS5L,
520489 - indicating chornic side effects. This is 40% improvement
520490 - compared to prior Labcorp and VA labs, shown on 140203 1147.
520491 - ref SDS 49 G34G Declining T Bilirubin may indicate recovering
520492 - liver function with low dose Atorvorstatin 10mg and Ezetimibe
520493 - 10mg prescribed by VA on 131219 0930, ref SDS 44 6H6K, and
520494 - which was started on 131230 on receipt of Ezetimibe 10mg,
520495 - reported case study on 120101 0900. ref SDS 15 6A6H Improving
520496 - liver function may align with declining peripheral neuropathy
520497 - from most severe effects; there have been no symptoms for past
520498 - 9 months, since 130614, reported in case study on 120101 0900.
520499 - ref SDS 15 TSUY Prior to 130614, there were no episodes for
520500 - several months reported on 130402, ref SDS 15 RURT, until
520501 - episode occurred on 130210. ref SDS 15 PV8I Major peripheral
520502 - neuopathy both feet on 130107. ref SDS 15 8H5F
520504 - ..
520505 - Background on Rosuvastatin causing elevated T Bilirubin with
520506 - associated severe side effects is reported on 121206 0900,
520507 - ref SDS 26 NI9L, and further explained in the record on 121130
520508 - 0846. ref SDS 25 ER4K
520510 - ..
520511 - On 131017 1000 Doctor Egan explained patient history of
520512 - intermittant and mild peripheral neuropathy that correlates
520513 - with persistent elevated T Bilirubin in lab on 131015,
520514 - ref SDS 33 015M, and further reported with vitals, diet and
520515 - exercise since prior meeting at VA on 130603, see case study on
520516 - 120101 0900, ref SDS 15 X14N, suggests intervention is not
520517 - required at this time to improve recovery from side effects
520518 - taking Rosuvastatin. ref SDS 36 LV5J
520520 - ..
520521 - On 131017 1000 VA medical chart Progress Notes assessment
520522 - report doctor concerned about chronic hyperbilirubinemia.
520523 - ref SDS 36 PSXT
520525 - ..
520526 - 2. Potasium K 5.6 Elevated above range......... ref SDS 0 ZG5O
520527 -
520528 - This is an increase from 4.8 on prior Labcorp lab and 5.4 on VA
520529 - lab from 3 months ago, shown on 140203 1147. ref SDS 49 ZG5O
520531 - ..
520532 - Doctor Egan, referring cardiology physician at Martinez VA,
520533 - noted in a recent letter that meeting at VA Medical Center in
520534 - San Francisco on 140213 0830, ref SDS 51 GT7G, did not address
520535 - elevated potassium in labs performed by Labcorp and VA, shown
520536 - on 140203 1147. ref SDS 49 ZG5O Doctor Egan again notifies
520537 - that this condition of elevated potassium represents exposure
520538 - to "electrical problems" with the heart, reported on 140430.
520539 - ref SDS 52 UV5I Doctor Egan was notified that results of
520540 - follow up lab today on 140508, would be presented to VA Medical
520541 - Center in San Francisco, shown in letter on 140505 0936,
520542 - ref SDS 53 YV5T
520544 - ..
520545 - Doctor Egan was concerned last year about potasium (K) rising
520546 - above range for good health. He explained potasium effects
520547 - electrical signals to the heart, and so has significance for
520548 - CVD, reported during meeting at VA on 121206 0900. ref SDS 26
520549 - 6K56
520551 - ..
520552 - At that time on 121206, the doctor cited medication conflicts
520553 - as possibly causing elevated potasium. ref SDS 26 FI7L Doctor
520554 - Egan further considered dehydration (urination) caused by
520555 - Rosuvastatin may have skewed lab results for electrolytes on
520556 - 121130, and so ordered re-test. ref SDS 26 6K4J
520558 - ..
520559 - On 121212 0941 re-test lab reported Glucose 111, sodium 139,
520560 - and potasium (K) 4.6, all within range, ref SDS 27 KK9M,
520561 - correcting errors noted by Doctor Egan during meeting at VA on
520562 - 121206 0900. ref SDS 26 6K4J
520564 - ..
520565 - At this time, dehydration from increased urination combined
520566 - with hiking 22 miles yesterday, and another 11 miles this
520567 - moring before the blood draw, reported in case study on 120101
520568 - 0900, ref SDS 15 4G5I, might reconcile elevated potasium (K
520569 - 5.6).
520571 - ..
520572 - 3. Glucose 97...................... ref SDS 0 ZG5O
520573 -
520574 - Glucose near upper range 99 presents risk diabetes. Like
520575 - potassium, per above, ref SDS 0 KZ5O, glucose may be elevated
520576 - by dehydration taking statin medication, and by hiking 22 miles
520577 - yesterday and 11 miles this morning before the lab, reported in
520578 - case study on 120101 0900. ref SDS 15 4G5I
520579 -
520580 - [On 140514 0950 VA lab for HGBA1c 5.4 within range 4 - 6
520581 - seems to indicate no evident exposure for diabetes.
520582 - ref SDS 58 H66G
520584 - ..
520585 - [On 140515 2043 letter notifies VA Medical Center in San
520586 - Francisco that glucose, sodium and potassium are elevated
520587 - above expected levels in Labcorp Lab on 140508, and reminds
520588 - that Doctor Egan issued request for re-lab because elevated
520589 - potassium presents electrical problems for the heart, which
520590 - is at risk in this case based on CABG +4 on 091022.
520591 - ref SDS 61 YM75
520593 - ..
520594 - [On 140518 2120 follow up letter reports that since VA has
520595 - not issued notice to do Electrolyte (Chem Profile) lab to
520596 - check glucose, sodium and potassium, customer will not
520597 - report lab for blood draw prior to meeting with VA at
520598 - Medical Center in San Francisco on 140519 0830. ref SDS 62
520599 - DV4M
520601 - ..
520602 - [On 140518 0920 at 2242 Doctor Alba notifies customer to
520603 - defer follow up chem profile (electrolyte) labs to verify
520604 - glucose, sodium and potassium elevated in Labcorp Lab on
520605 - 140508, responding to Doctor Egan's request based on
520606 - potential for potassium to cause heart problems.
520607 - ref SDS 62 NY4F
520608 -
520609 -
520610 -
520611 -
520612 -
520613 -
520614 -
520615 -
520616 -
5207 -
SUBJECTS
Labcorp Lab Lipid Cholesterol 162 Stable with Atorvastatin 10mg Ezet
6903 -
690401 - ..
690402 - LDL-C 83 LDL-P 851 LDL Size Large Hike 900 Miles Weight Lose 15 Pounds
690403 -
690404 - Follow up ref SDS 49 IM9N, ref SDS 48 IM9N.
690405 -
690406 - Results today reported by Labcor using NMR technology align with
690407 - increased hiking and weight loss past 3.5 months, reported in case
690408 - study on 120101 0900, ref SDS 15 NC4N, and reflect changes in diet and
690409 - medication, reported on 140508, in the same study. ref SDS 15 UG6N
690410 -
690411 - [On 140510 2056 received letter from Health Testing Centers
690412 - transmitting report on lab results. ref SDS 55 4Q6I
690414 - ..
690415 - [On 140515 2043 VA notified consolidated test results show
690416 - progress lowering CVD risk with improved lipid management.
690417 - ref SDS 60 IM9N
690419 - ..
690420 - Prior LIPID PANEL 120509 1108. ref SDS 20 IM9N
690421 - Prior LIPID PANEL 120831 1525. ref SDS 21 IM9N
690422 - Prior LIPID PANEL 130228 1140. ref SDS 29 IM9N
690423 - Prior LIPID PANEL 130529 0818. ref SDS 31 IM9N
690424 - Prior LIPID PANEL 131015 0724, ref SDS 33 IM9N
690425 - Prior LIPID PANEL Labcorp, 140201 1159, ref SDS 48 IM9N
690426 - Prior LIPID PANEL, 140203 1147, ref SDS 49 IM9N
690428 - ..
690429 - LIPIDS
690431 - ..
690432 - LIPID Panel....2014 05 08 1149 140203 140201 131015 130529
690433 - Labcorp VA Labcorp VA VA VA Labcorp
690434 - NMR LipoProfile Results Results Results Results Results Units Range Range
690435 - LDL Particle Number
690436 - LDL-P 851.0 861.0 nmol/L < 1000
690437 - <ow < 1000
690438 - Moderate 1000 - 1299
690439 - Borderline High 1300 - 1599
690440 - High 1600 - 2000
690441 - Very High > 2000
690443 - ..
690444 - Lipids
690445 - CHOL 162 160 156 321 H 307 mg/dL Ref: <=200 < 200
690446 - TRIGLYC 59 47 68 109 85 mg/dL Ref: <=150 < 150
690447 - HDL-C 67 58 61 50 50 mg/dL Ref: >=40 >= 40
690448 - LDL-C 83 93 81 249 H 240 mg/dL Ref: <=160 < 100
690449 - LDL Dir mg/dL Ref: <=160
690450 - TRIG NF mg/dL Ref: <=150
690452 - ..
690453 - TG/HDL ratio........... 0.88 0.81 1.11 < 2.0
690455 - ..
690456 - LDL and HDL Particles
690457 - HDL-P (Total) 38.1 31.4 umol/L >= 30.5
690458 - Small LDL-P < 90.0 < 90.0 umol/L <=527.0
690459 - LDL Size 21.2 21.3 nm > 20.5
690461 - ..
690462 - --------------------------------------------------------
690463 - ** INTERPRETATIVE INFORMATION**
690464 - PARTICLE CONCENTRATION AND SIZE
690466 - ..
690467 - LDL AND HDL PARTICLES Percentile in Reference Population
690468 - HDL-P (total) High 75th 50th 25th Low
690469 - >34.9 34.9 30.5 26.7 <25.7
690470 - ..
690471 - Small LDL-P Low 25th 50th 75th High
690472 - <117 117 527 839 >839
690474 - ..
690475 - LDL Size <- Large (Pattern A)-> <- (Pattern B) ->
690476 - 23.0 20.6 20.5 19.0
690478 - ..
690479 - --------------------------------------------------------
690480 - Insulin Resistance/Diab. Risk
690481 - Large VLDL-P < 0.8 nmol/L <= 2.7
690482 - Small LDL-P < 90.0 nmol/L < 527
690483 - Large HDL-P 9.4 umol/L >= 4.8
690485 - ..
690486 - VLDL Size NOTES nm
690487 -
690488 - VLDL concentration too low to allow determination of VLDL
690489 - Size. Low VLDL concentration contributes minimally to the
690490 - LP-IR score.
690492 - ..
690493 - LDL Size 21.2 nm >= 20.8
690494 - HDL Size 9.8 nm >= 9.2
690495 -
690496 - Small LDL-P, LDL Particle Size, Large HDL-P VLDL Size, HDL
690497 - Size, HDL Particle, and LP-IR Score have been validated by
690498 - LipoScience but not cleared by US FDA; the clinical
690499 - utility of these tests has not been fully established.
690501 - ..
690502 - Insulin Resistance Score
690503 - LP-IR Score < 25.0 < 25.0 <= 45.0
690504 -
690505 - LP-IR Score is inaccurate if patient is non-fasting. The
690506 - LP-IR Score combines the information from Large VLDL-P,
690507 - Small LDL-P, Large HDL-P, VLDL Size, LDL Size and HDL Size
690508 - to give improved assessment of insulin resistance and
690509 - diabetes risk.
690511 - ..
690512 - INSULIN RESISTANCE MARKER
690513 -
690514 - <--Insulin Sensitive Insulin Resistant-->
690515 - Percentile in Reference Population
690516 -
690517 - Large VLDL-P Low 25th 50th 75th High
690518 - <0.9 0.9 2.7 6.9 >6.9
690520 - ..
690521 - Small LDL-P Low 25th 50th 75th High
690522 - <117 117 527 839 >839
690524 - ..
690525 - Large HDL-P High 75th 50th 25th Low
690526 - >7.3 7.3 4.8 3.1 <3.1
690528 - ..
690529 - VLDL Size Small 25th 50th 75th Large
690530 - <42.4 42.4 46.6 52.5 >52.5
690532 - ..
690533 - LDL Size Large 75th 50th 25th Small
690534 - >21.2 21.2 20.8 20.4 <20.4
690536 - ..
690537 - HDL Size Large 75th 50th 25th Small
690538 - > 9.6 9.6 9.2 8.9 < 8.9
690540 - ..
690541 - Insulin Resistance Score
690542 - LP-IR Score Low 25th 50th 75th High
690543 - <27 27 45 63 >63
690544 -
690546 - ..
690547 - Cardiovascular Risk Assessment
690549 - ..
690550 - Interpretation
690552 - ..
690553 - For Interpretations, please refer to Litholink CDS Patient
690554 - Report.
690556 - ..
690557 - PDF Image
690559 - ..
690560 - 01 SO Kelli Chase, MD
690561 - Labcorp San Diego
690562 - 13112 Evening Creek Dr So Ste 200 San Diego, CA
690563 - 92128-4108
690565 - ..
690566 - 02 S7 Deanna Franke, PhD
690567 - Liposcience Inc
690568 - 2500 Sumner Blvd, Raleigh, NC 27616-3235
690570 - ..
690571 - 03 S7 Mitchell Laks, PhD
690572 - Litholink Corporation
690573 - 2255 W Harrison Street Ste B, Chicago, IL 60612-4670
690575 - ..
690576 - For inquiries, the physician may contact Branch: 800 762 4344
690577 - Lab: 858 668 3700
690579 - ..
690580 - Comments:
690581 -
690582 - a. Test Performed at...
690583 - Health Testing Centers
690584 - 2760 W. OAKLAND PARK BLVD.
690585 - FORT LAUDERDALE FL 33311
690587 - ..
690588 - b. Medical Director's Note: On November 12, 2013, the ACC/AHA
690589 - released new guidelines on cholesterol treatment in adults
690590 - (Stone NJ et al. 2013 ACC/AHA guideline on the treatment of
690591 - blood cholesterol to reduce atherosclerotic cardiovascular
690592 - risk in adults: a report of the American College of
690593 - Cardiology/American Heart Association Task Force on
690594 - Practice Guidelines. Circulation. 2013; 00:000-000.) The
690595 - new guidelines do not make a recommendation for or against
690596 - use of LDL-C or non-HDL-C targets, but instead identify
690597 - patient groups who would benefit from statin therapy.
690598 - Until a consensus has been reached, the suggestions in this
690599 - report continue to reflect the ATP III guidelines. For
690600 - Interpretations, please refer to Litholink CDS Patient
690601 - Report.
690603 - ..
690604 - c. VA Evaluation for LDL-CHO:
690605 -
690606 - RISK CATEGORY LDL GOAL
690607 - CHD and CHD risk equivalents <100 mg/dL
690608 - Multiple (2+) risk factors <130 mg/dL
690609 - 0-1 risk factor <160 mg/dL
690611 - ..
690612 - HDL Chol. greater than/equal to 60 mg/dL counts as
690613 - "negative" risk factor; its presence removes 1 risk factor
690614 - from the total count.
690616 - ..
690617 - Ref: Adult Treatment Panel III (ATP III) JAMA 5/16/01 Vol.
690618 - 285 #19.
690620 - ..
690621 - d. Format and scope Labcorp lab report changed by adding
690622 - metrics on VLDL, above, ref SDS 0 S16F, that was omitted in
690623 - prior Labcorp report for blood draw on 140201 1159.
690624 - ref SDS 48 WR9H
690626 - ..
690627 - Analysis....
690628 -
690629 - 1. LDL-P 851, ref SDS 0 U45J, represents lower CVD risk and
690630 - improving lipid management. LDL-C 83 increased 2 points from
690631 - prior lab on 140201. It remains low concordant with LDL-P, but
690632 - moving toward discordance. Research indicates healthiest
690633 - cardiovascular condition occurs with lowest risk for CVD, when
690634 - lipids are discordant, with LDL-P low and LDL-C high, shown in
690635 - the record on 131125 0005. ref SDS 41 FI3G
690637 - ..
690638 - VA published goal for LDL-C <= 160; Labcorp published goal
690639 - LCL-C < 100. ref SDS 49 5C7M New AHA guidelines show LDL-C <
690640 - 190, reported on 131112 1422. ref SDS 39 HT87
690642 - ..
690643 - NMR test lists LDL-P < 1600 for "borderline" CVD high risk, and
690644 - that below 1000, is "low," meaning minimal risk for CVD.
690645 - ref SDS 49 U45J Thus, LDL-P 851 in this test presents low risk
690646 - for CVD. Research on 131125, lists LDL-P < 700 may be a better
690647 - target to manage CVD risk. ref SDS 41 WY9H The same research
690648 - also cites LDL-P < 1000 for evaluating CVD risk, similar to NMR
690649 - test today. ref SDS 41 OQ9N
690651 - ..
690652 - When can patients be confident LDL-P < 700, 600, 200 - is low
690653 - enough to work on other aspects of daily life?
690655 - ..
690656 - 2. LDL-P 851 in Labcorp test today on 140508, correlates with
690657 - TG/HDL ratio 59/67 = 0.88. ref SDS 0 5C7M Research indicates
690658 - TG/HDL ratio correlates to LDL-P vaulations produced by NMR
690659 - testing, reported on 131125 0005. ref SDS 41 666G
690661 - ..
690662 - 3. Resting heart rate getting up in the morings has fallen below
690663 - 50. Blood pressure varies - averages about 115 65. After
690664 - hikes about 105 55. Systalic on occassion falls below 100.
690665 - Dystalic has fallen below 50 - e.g., see Monday 140428 reported
690666 - in case study on 120101 0900. ref SDS 15 CB6N
690668 - ..
690669 - 4. LDL-P 851 and HDL 67 and Triglycerides 59 on 140508, indicate
690670 - low risk for CVD, per above analysis, ref SDS 0 RV5M, and may
690671 - align with hiking 22 miles yesterday on 140507, and 11 miles
690672 - this morning at 0400 (see again case study - ref SDS 15 4G5I),
690673 - before doing the blood draw later this morning at 1149.
690674 - ref SDS 0 U45J
690676 - ..
690677 - 5. Lipid favorable results in NMR test on 140201, and follow up
690678 - test at VA on 140203, occurred concurrent with...
690679 -
690680 - a. Hiking 888 miles since prior lab on 140201, reported in
690681 - case study 120101 0900, ref SDS 15 P36G, including 22 miles
690682 - the day before, and another 11 miles the morning before
690683 - blood draw, and recommended in research on 131125 0005.
690684 - ref SDS 41 QP9F including regular aerobic exercise to lower
690685 - triglycerides. ref SDS 41 JV5O
690687 - ..
690688 - b. Weight - hit 165 on 140420, and held for 3 days, shown in
690689 - case study on 120101 0900. ref SDS 15 TO6O This is
690690 - continuing challenge bouncing around from over 200 in 2011,
690691 - but varied significantly.
690693 - ..
690694 - c. Low-carbohydrate diet lowers triglycerides (TG 59 in
690695 - Labcorp test, per above, ref SDS 0 5C7M), which together
690696 - with higher HDL 67 (TG/HDL ratio < 2) combine to lower
690697 - LDL-P, cited in research on 131125 0005. ref SDS 41 QP9F
690699 - ..
690700 - d. Chia seeds added to diet on 131125, reported in case study
690701 - on 120101 0900, ref SDS 15 746M, and recommended by Karen
690702 - at VA on 131121 0930. ref SDS 40 NQ37
690704 - ..
690705 - e. Orange juice added to diet on 131125, based on study
690706 - indicating HDL increase 21%, ref SDS 41 R48K, as reported
690707 - to VA in letter on 140114 0845. ref SDS 45 218O
690709 - ..
690710 - f. Atorvastatin 10 mg reduced 131230, and added Ezetimibe 10
690711 - mg reported in case study, ref SDS 15 6A6H
690713 - ..
690714 - Research cites studies that report Atorvastatin 10 mg +
690715 - Ezetimibe 10 mg achieves LDL < 70, and favorably changes
690716 - triglycerides and HDL by 5%, reported on 131125 0005.
690717 - ref SDS 41 CO45 While low LDL < 70 conflicts with goal of
690718 - "discordance" that lowers health risk for arterialsclorosis
690719 - and CVD when LDL-P low and LDL-C high, shown in research on
690720 - 131125 0005, ref SDS 41 FI3G, even "concordant" results
690721 - today are good news.
690723 - ..
690724 - Since prior lab on 140201, until lab at VA today on 140508,
690725 - case study shows on 120101, ref SDS 15 E47L, patient has
690726 - taken...
690727 -
690728 - 1. Atorvastatin............... 900 mg
690729 - 2. Ezetimibe.................. 900 mg
690730 -
690732 - ..
690733 - Lipid History Trend Analysis
690734 -
690735 - Follow up ref SDS 25 W25L.
690736 -
690737 - Small LDL LP-IR
690738 - Collection DT CHOL TRIGL HDL LDL-C LDL-P HDL-P LDL-P SIZE SCORE
690739 - 05/08/2014 11:49 162 59 67 83 851 38.1 < 90 21.2 < 25 ..... ref SDS 0 BE6O
690740 - 02/03/2014 12:28 160 H 47 58 93 ......................................... ref SDS 49 BE6O
690741 - 02/01/2014 12:31 156 68 61 81 861 31.4 < 90 21.3 < 25 ..... ref SDS 48 BE6O
690742 - 10/15/2013 08:25 321 H 109 50 249 H ......................................... ref SDS 33 BE6O
690743 - 05/29/2013 08:18 307 H 85 50 240 H ......................................... ref SDS 29 BE6O
690744 - 02/28/2013 08:39 310 H 73 47 248 H ......................................... ref SDS 29 BE6O
690745 - 11/30/2012 10:01 173 53 57 105 ......................................... ref SDS 25 BE6O
690746 - 08/31/2012 15:25 176 94 47 110 ......................................... ref SDS 21 U89N
690747 - 05/09/2012 11:24 158 76 49 94 ......................................... ref SDS 20 U89N
690748 - 02/09/2012 11:18 285 82 41 228 H ......................................... ref SDS 16 2A4G
690749 - 11/17/2011 14:27 260 84 43 200 H ......................................... ref SDS 14 2A4G
690750 - 07/27/2011 12:58 163 81 45 102 ......................................... ref SDS 10 E19L
690751 - 12/07/2010 09:17 151 41 47 96 ......................................... ref SDS 9 E19L
690752 - 07/21/2010 08:54 261 H 87 35 L 209 H ......................................... ref SDS 5 E19L
690753 - 06/10/2010 10:33 217 H 83 36 L 164 H ......................................... ref SDS 4 QV4F
690754 - * 12/14/2009 11:10 241 H 136 44 170 H ......................................... 100928 0706, ref SDS 6 VW6J
690755 - 08/13/2009 15:09 233 H 118 30 L 179 H ......................................... 100610 1046, ref SDS 4 U45G
690756 - 06/16/2006 10:59 238 H 68 32 L 192 H ......................................... 091002 0900, ref SDS 2 LJ5H
690757 -
690758 - [...140515f2043ref SDS 60 YM56
690759 -
690760 - * Lab at VA San Francisco Medical Center reported on 100928 0706.
690761 - ref SDS 6 VW6J
690763 - ..
690764 - Research on cholesterol reported on 091002 0900. ref SDS 2 2F8K
690766 - ..
690767 - On 131125 0005 research found ezetimibe (zetia) mg added to
690768 - Atorvastatin 20 mg yielded after 6 weeks significantly greater changes
690769 - to lipids than taking Atorvastatin in higher doses, e.g., 20 or 40 mg.
690770 - ref SDS 41 CO56
690772 - ..
690773 - On 131125 0005 research found discordance LDL-P low and LDL-C high
690774 - lipid panel HDL 65 TG 77 healthy patient profile with LDL 246.
690775 - ref SDS 43 MN98 Discordance with LDL-P low and LDL-C high is lowest
690776 - risk for CVD, arterialsclorosis. 131125 0005, ref SDS 41 FI3G
690777 -
690779 - ..
690780 - Coronary CTA or IVUS Test Athereosclerosis Plaque 4 Years After CABG
690781 - Athereosclerosis Plaque 4 Years After CABG Coronary CTA or IVUS Test
690782 -
690783 - On 131125 0005 research further found radiology imaging tests can
690784 - evaluate level of plaque build up resulting from elevated cholesterol.
690785 - ref SDS 42 N73K Radiology imaging technologies are Coronary CT
690786 - angiography - CTA - and Intravascular ultrasound - IVUS. ref SDS 41
690787 - KZ8O
690789 - ..
690790 - Lipid history and particularly the past 6 months with HDL > 60 and
690791 - Triglycerides < 100, ref SDS 0 W25L, indicates patient may have change
690792 - body chemestry sufficient to cause rapid regression of atherosclerosis
690793 - plaque, cited in research on 131125 0005. ref SDS 41 RA7K Research
690794 - indicates that favorable lipid profile, weight loss, and production of
690795 - EPC in the bone marrow, all stimulated by exercise, drives regression
690796 - of plaque. ref SDS 41 XY7L
690797 -
690798 -
690799 -
690800 -
690801 -
690802 -
690803 -
690804 -
690805 -
690806 -
690807 -
690808 -
690809 -
6909 -
SUBJECTS
VA Lab Cardiac Enzymnes Creatine Kinase CK 149 Range 36 340 Measures
7503 -
750401 - ..
750402 - Myopathy Muscle Pain Side Effects Simvistatin Decline
750403 -
750404 - Follow up ref SDS 49 D26G, ref SDS 48 D26G.
750405 -
750406 - Prior Cardiac Enzymes Profile on 120209 1118. ref SDS 16 D26G
750407 - Prior Cardiac Enzymes Profile on 120509 1108. ref SDS 20 D26G
750408 - Prior Cardiac Enzymes, 131015 0724, ref SDS 33 D26G
750409 - Prior Cardiac Enzymes Profile VA on 140203 1147. ref SDS 49 NX6G
750411 - ..
750412 - This test not performed by Labcorp with blood draw on 140508...
750413 -
750414 - CARDIAC ENZYMES
750415 -
750416 - DATE 2014 05 08 1149 140203 131015 120509
750417 - Labcorp VA VA VA
750418 - PLASMA Results Results Results Results Units Range
750419 - CK 149 110 152 IntUnits/L 36 - 340
750420 - TRPONIN ng/ml 0 - 0.07
750421 - CK-MB ng/ml 0.6 - 3.5
750422 - MYOGLOB ng/ml 20 - 82
750424 - ..
750425 - a. CK or CPK test not performed by Labcorp
750427 - ..
750428 - b. TEST PERFORMED BY VAMC SACRAMENTO, 10535 HOSPITAL WAY,
750429 - MATHER CA.
750431 - ..
750432 - Research on 111013 explains Creatine Kinase CK, relates to muscle
750433 - disorders caused by cholesterol medications with statins. 111013 1404,
750434 - ref SDS 13 J54K
750436 - ..
750437 - CK lab may align with reduced side effects of muscle pain in left
750438 - shoulder.
750439 -
750440 -
750441 -
750442 -
750443 -
750444 -
7505 -
SUBJECTS
HGBA1C 5.5 Range 4.1-6.2 Diabetes Negative Laboratory Blood Test Cro
A403 -
A40401 - ..
A40402 - HGBA1c Diabetes Blood Test
A40403 - Diabetes Blood Test HGBA1c
A40404 -
A40405 - Follow up ref SDS 49 9F4O, ref SDS 48 9F4O.
A40406 -
A40407 - Prior HGBA1c Profile on 100721 0800. ref SDS 5 IL4N
A40408 - Prior HGBA1c Profile on 101207 0906. ref SDS 9 IL4N
A40409 - Prior HGBA1c Profile on 131015 0724. ref SDS 33 9F4O
A40410 - Prior HGBA1c Profile on 140203 1147. ref SDS 49 9F4O
A40412 - ..
A40413 - This test not performed by Labcorp with blood draw on 140508...
A40414 -
A40415 - HGBA1c
A40416 -
A40417 - HGBA1c.........2014 05 08 1149 140203 131015 101207
A40418 - Labcorp VA VA VA
A40419 - BLOOD Results Results Results Results Units Range
A40420 - HGBA1c 5.5 5.5 5.7 % 4.1 - 6
A40421 - eAG 111 111 mg/dL 74.0 - 118
A40423 - ..
A40424 - Comments:
A40425 -
A40426 - a. Labcorp did not perform HGBA1c lab
A40427 -
A40428 - b. TEST PERFORMED BY VA MARTINEZ, 150 MUIR ROAD, MARTINEZ CA.
A40429 -
A40430 - eAG = Calculated Estimated Average Daily Glucose and may be
A40431 - easier for patients to understand than an A1c result.
A40432 - Calculation: 28.7 x HGBA1c - 46.7
A40434 - ..
A40435 - Ordering Provider: Harkesh S. Sandhu MD
A40436 - Report Released: Oct 15, 2013 @ 1309
A40438 - ..
A40439 - Reporting Lab: MARTINEZ OPC/CREC
A40440 - 150 MUIR ROAD MARTINEZ, CA 94553-4668
A40442 - ..
A40443 - Performing Lab: MARTINEZ OPC/CREC
A40444 - 150 MUIR ROAD MARTINEZ, CA 94553-4668
A40445 -
A40447 - ..
A40448 - This test for diabetes was ordered by Doctor Abrams during a meeting
A40449 - at the San Francisco VA Medical Center on 130227 0930. ref SDS 28 8T5L
A40450 - However, it is not reported for the lab performed the next day on
A40451 - 130228 1140, ref SDS 29 RP4N, nor in the follow up lab 3 months later
A40452 - on 130529 0818. ref SDS 31 RP4N
A40454 - ..
A40455 - HGGA1c was performed previously on 101207 0906, ref SDS 9 IL4N, and 5
A40456 - months earlier on 100721 0800. ref SDS 5 IL4N
A40458 - ..
A40459 - Labcorp test showing LP-IR Score < 25.0, indicating very low risk of
A40460 - diabetes, reported today, above. ref SDS 0 TU6L
A40461 -
A40462 -
A40463 -
A40464 -
A40465 -
A40466 -
A40467 -
A40468 -
A40469 -
A405 -